Struggling to Solve Your Particular Breastfeeding Difficulty?

CASE SCENARIO:

A mom presents three months postpartum with a history of an emergency C-Section at 33 weeks pregnant with twins because one of twins had severe restricted growth (he was 2lbs less in weight than his twin at birth). She never had any milk supply issues and is producing upwards of 60 oz of breastmilk per day.

She is crying and frustrated that her Obstetrician diagnosed her with mastitis for the third time. The diagnosis and treatment was over the phone and this mother was never evaluated in person. She was prescribed antibiotics again with no explanation as to why this keeps happening. She states she’s done pumping, with constant pain, and wants to wean as she cannot deal with this when she returns to work in 2 weeks.

She has also seen two different Lactation Consultants over 4 visits. “Nothing has helped me because all they want me to do is put both babies at the breast. I can never get them to latch which is why I preferred to pump.” This mom was also advised to pump every 2 hours. This schedule barely left her an hour to sleep between feedings once she finished pumping and feeding both babies.

She reports not feeling as connected to her babies as she would like due to her pain and feeling “tied to her breast pump”. Her husband is extremely supportive, however he is barely home due to his work load. In addition, there are no extended family members living nearby for added support.

RESOLUTION:

If you read my previous article, you can understand why I schedule 90 minute visits. The above situation is more complicated than the standard 15 min visit you get if you went to the doctor’s office. You can see already this mom has already been in contact with her OB, Lactation Consultants, and the babies have been evaluated by their Pediatrician on multiple occasions. Yet not one of these providers involved with this mother have coordinated care or shared information with each other to improve her situation in the last 3 months.

Here’s what can be accomplished during an initial lactation consult visit:

• Full history and physical assessments of both babies
• Postpartum depression screening
• Full medical history and breast examination of mother
• Pumping session assessment.

Mother clearly was exhibiting signs and symptoms of depression, so we called her Obstetrician who agreed to temporarily prescribe an antidepressant and after that scheduled an appointment with a therapist who agreed to see her within 48 hours.

Now, although this mom on examination did have mastitis it was determined that antibiotics were not necessary at this point. The situation could be managed conservatively and explained measures to decrease the inflammatory process. The excessive pumping schedule of every 2 hours created over production of breastmilk. Poor fitted breast pump flanges that were too small exacerbated the mastitis.

Her symptoms resolved within 48 hours after she:

• changed to proper sized breast pump flanges
• increased time between pumping sessions to every 4 hours (with a plan to gradually increase the times between pumpings to decrease milk supply so she could eventually wean per her wishes)
• used Motrin and ice packs for comfort

Unfortunately, many providers do not realize 80% of mastitis is primarily a continuum of inflammation and can be treated conservatively without the use of antibiotics.

Solutions Found

She also had two close friends in the area who were willing to help with the care of the babies. In addition, they were willing to assist with cleaning bottles and pump parts, and bringing in meals so mother could have some extra sleep/rest. This afforded mom more bonding time with her babies that ultimately improved her mood. She wanted an extra week in addition to the 2 weeks of leave she had left but was afraid to ask. So, I had her call her boss while I was there who was extremely understanding and extended her leave. The expression of relief on her face after that phone call was undeniable.

The assessment of both babies revealed adequate weight gains and growth, however in the smaller twin there were significant abnormalities in muscle tone, asymmetric facial features due to moderate misshapen skull that’s called Plagiocephaly. Despite adjusting his age for prematurity he was showing developmental delays. This was not an immediate danger. Still, I discussed the findings and potential diagnoses with mom briefly as I assured her that we could delve more into these findings when I returned the next week for a follow-up. In the meantime, I left a message with the Pediatrician and alerted staff that I would fax my assessment and treatment notes with the anticipated referrals needed so they could also closely monitor this baby’s progress.

After three months, four different healthcare providers could not achieve success. However, the results of an initial lactation consult visit and one follow up visit provided by a pediatric nurse practitioner/IBCLC with extensive training and experience gave the mother and babies the answers needed. This mother’s mastitis completely resolved without the need for antibiotics and never had another recurrence. She was so satisfied and surprised that the every 4 hour pumping schedule was completely manageable, she decided not to wean and continued to pump even after returning to work. She provided breastmilk to her twins for an entire year.

She was able to discontinue her antidepressant medications after just 6 weeks but continued therapy for a total of 6 months at which time she was feeling much better and no longer required further sessions. Both babies did very well but one twin was still receiving physical therapy, speech therapy, and did eventually require cranial banding to address his skull shape. Two years later she had another baby without experiencing postpartum depression and successfully breastfed for 15 months.

Art and Practice

This scenario is only one example of so many cases where the current healthcare system can easily fail patients. Medicine and nursing are both an art and a science. Many have discarded the art of practice and have forgotten that science is not absolute. It’s the art of medicine and nursing practice that allows nuance, common sense, and critical thinking to augment our decision-making when the science is lacking or incomplete and stokes the curiosity of finding the answers when there appear to be none.

If you desire a more personalized nuanced approach to your breastfeeding concerns especially if you and/or your baby have a complex medical history or needs, please schedule your FREE 30 MINUTE MEET AND GREET TODAY. Call 307-212-8283; Visit www.milkwagon.net for more information.

This article is proudly sponsored by Cody Calendar advertisers